TITLE

Long-term endoscopic surveillance of patients with Barrett's esophagus. incidence of dysplasia and adenocarcinoma: a prospective study

AUTHOR(S)
Conio, Massimo; Blanchi, Sabrina; Lapertosa, Gabriella; Ferraris, Roberto; Sablich, Renato; Marchi, Santino; D'Onofrio, Vittorio; Lacchin, Teresa; Iaquinto, Gaetano; Missale, Guido; Ravelli, Paolo; Cestari, Renzo; Benedetti, Giorgio; Macrì, Giuseppe; Fiocca, Roberto; Munizzi, Francesco; Filiberti, Rosangela
PUB. DATE
September 2003
SOURCE
American Journal of Gastroenterology;Sep2003, Vol. 98 Issue 9, p1931
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
: ObjectiveBarrett''s esophagus (BE) is a premalignant condition for which regular endoscopic follow-up is usually advised. We evaluated the incidence of esophageal adenocarcinoma (AC) in patients with BE and the impact of endoscopic surveillance on mortality from AC.: MethodsA cohort of newly diagnosed BE patients was studied prospectively. Endoscopic and histological surveillance was recommended every 2 yr. Follow-up status was determined from hospital and registry office records and telephone calls to the patients.: ResultsFrom 1987 to 1997, BE was diagnosed in 177 patients. We excluded three with high-grade dysplasia (HGD) at the time of enrollment. Follow-up was complete in 166 patients (135 male, 31 female). The mean length of endoscopic follow-up was 5.5 yr (range 0.5–13.3). Low-grade dysplasia (LGD) was present initially in 16 patients (9.6%) and found during follow-up in another 24 patients. However, in 75% of cases, LGD was not confirmed on later biopsies. HGD was found during surveillance in three patients (1.8%), one with simultaneous AC; two with HGD developed AC later. AC was detected in five male patients during surveillance. The incidence of AC was 1/220 (5/1100) patient-years of total follow-up, or 1/183.6 (5/918) patient-years in subjects undergoing endoscopy. Four AC patients died, and one was alive with advanced-stage tumor. The mean number of endoscopies performed for surveillance, rather than for symptoms, was 2.4 (range 1–10) per patient. During the follow-up years the cohort had a total of 528 examinations and more than 4000 biopsies.: ConclusionsThe incidence of AC in BE is low, confirming recent data from the literature reporting an overestimation of cancer risk in these patients. In our patient cohort, surveillance involved a large expenditure of effort but did not prevent any cancer deaths. The benefit of surveillance remains uncertain.
ACCESSION #
10807790

 

Related Articles

  • Endoscopic surveillance for Barrett's esophagus does not improve cancer survival.  // Hem/Onc Today;10/25/2013, Vol. 14 Issue 20, p39 

    The article presents the results of a case-control study as of late October 2013, which showed that patients with Barretts esophagus who underwent endoscopic surveillance are not at lower mortality risk from esophageal adenocarcinoma.

  • Long-term Follow-up of Barrett's High-Grade Dysplasia. Weston, Allan P.; Sharma, Prateek; Topalovski, Margaretia; Richards, Robert; Cherian, Rachel; Dixon, Anita // American Journal of Gastroenterology;Aug2000, Vol. 95 Issue 8, p1888 

    OBJECTIVE: The management of Barrett's high-grade dysplasia (HGD) remains controversial. The aims of this study were to evaluate prospectively the outcome of unifocal HGD (uHGD) in patients with Barrett's esophagus, and to determine demographic and endoscopic features predictive of progression...

  • Adenocarcinoma of the Esophagus and Barrett's Esophagus: A Population-Based Study. Bytzer, Peter; Christensen, Peer Brehm; Damkier, Per; Vinding, Kirsten; Seersholm, Niels // American Journal of Gastroenterology;Jan1999, Vol. 94 Issue 1, p86 

    Objective: We described incidence rates of esophageal adenocarcinoma in Denmark in a 20-yr period and determined the proportion of patients diagnosed with esophageal adenocarcinoma who had a previous diagnosis of Barrett's esophagus, making them potential candidates for endoscopic surveillance....

  • IS THERE A SURGICAL NIRVANA FOR BARETT'S ESOPHAGUS? Öberg, Stefan; Mason, Rodney J.; Johnson, David // American Journal of Gastroenterology;Dec1996, Vol. 91 Issue 12, p2630 

    Discusses the antireflux surgery of patients with Barrett's esophagus. Definition of Barrett's esophagus; Information on the occurrence of esophageal adenocarcinoma; Role of antireflux procedure in the development of adenocarcinoma;

  • ASPECTE EPIDEMIOLOGICE, ETIOPATOGENICE, CLINICE ÅžI DIAGNOSTICE ÃŽN CANCERUL GASTRIC. VintilĂ, Marius; Andercou, Aurel; Duse, Adrian // Clujul Medical;Jun2012, Vol. 85 Issue 2, p155 

    Gastric neoplasm is one of the most common digestive tract cancers, entailing a high mortality rate. Gastric adenocarcinoma represents over 95% of gastric malignant tumours, therefore the generic term gastric cancer mostly refers to adenocarcinoma. The gold standard in the diagnosis of gastric...

  • Screening for Barrett's Esophagus. DeVault, Kenneth R. // American Family Physician;5/1/2004, Vol. 69 Issue 9, p2061 

    Focuses on the endoscopic screening of Barrett's esophagus. Association between esophageal adenocarcinoma and gastroesophageal reflux disease; Biopsy of esophageal mucosa required for the diagnosis of Barrett's esophagus; Health risk of the routine biopsy of a squamocolumnar junction.

  • The Development of Dysplasia and Adenocarcinoma During Endoscopic Surveillance of Barrett's Esophagus. Katz, David; Rothstein, Richard; Schned, Alan; Dunn, John; Seaver, Kim; Antonioli, Donald // American Journal of Gastroenterology;Apr1998, Vol. 93 Issue 4, p536 

    Objective: Periodic endoscopic surveillance is generally recommended for patients with Barrett's esophagus. The optimal follow-up strategy for uncomplicated Barrett's esophagus is controversial, in part because of limited data on the rate of neoplastic progression (through the sequence of...

  • Endoscopic Surveillance of Barrett's Esophagus: A Cost-Effectiveness Comparison With Mammographic Surveillance for Breast Cancer. Streitz Jr., John M.; Ellis Jr., Henry; Tilden, Robert L.; Erickson, Robert V. // American Journal of Gastroenterology;Jun1998, Vol. 93 Issue 6, p911 

    Objective: Endoscopic surveillance of Barrett's esophagus is commonly practiced to detect malignancy in an early and curable stage. However, the cost-effectiveness of this practice has been questioned. To clarify this issue, we undertook a cost analysis of endoscopic surveillance to detect...

  • Upper endoscopy as a screening and surveillance tool in esophageal adenocarcinoma: a review of the evidence. Shaheen, Nicholas J.; Provenzale, Dawn; Sandler, Robert S. // American Journal of Gastroenterology;Jun2002, Vol. 97 Issue 6, p1319 

    Esophageal adenocarcinoma is a rare cancer that is increasing rapidly in incidence. Because gastroesophageal reflux disease (GERD) is a risk factor for the development of this cancer, endoscopic screening of individuals with GERD symptoms and endoscopic surveillance of those who are found to...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics